Forked tongue cases!
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Photos courtesy Rajiv Patel - ROOTS
From: Rajiv Patel
Sent: Saturday, June 20, 2009 5:48 PM
Subject: [roots] Forked tongue cases!
Had 2 in a week with these forked apical splits. Had to squirt
the Db canal on the maxillary molar - while hand instrumentation
could sense multiple apical picks during recaps.
The mandibular molar was reasonably easier...(; - Rajiv Patel
Forgot to add this from the same week - 3 visits on a premolar
with a deep split. Some times you gotta use your finger
(seen in radiograph) to get a decent rad. This fine lady was
missing her canines and had a shallow palate - any suggestions
for getting better radiographs on these without being in the
line of fire?? - Rajiv
Rajiv,'the way to get off line of fire is to push somebody
else in there :-) Usually it could be..guess who?... the
patient :-) - Dmitri
Superb! - RafaŽl
beautiful work Rajiv - Imran
Hi Rajiv, Beautiful work as usual !
Do your referrals have a problem with you doing the permanent
restoration? I still have your presentation on "coronal seal"
:-))) - Siju
Thanks Siju. You are right Siju - there are some referrrals
who have a preference to place the permanent restoration.
We have a list of referrals who want us to place the seal.
It can be a very sensitive topic to broach...but as
endodontists we are known to get on other people's NERVES...
(; - Rajiv
Very Nice. What radiography system do you use? - Roman Bakowicz
It's a Schick system. Thanks for your comments - Rajiv
Dr.Patel: Wonderfull shapings. Could you describe for us your
instrument sequence for the mesials canals of
the treated first inferior molar? - Laura
Here is my not so fancy instrumentation - Shaping and cleaning
not so rigid regimen:
1. Checking /Scouting for canal curvatures with small hand files
2. Use hand instruments in a crown down manner - makes it easy
for smaller files to gain length easily
3. Gates - 3 & 2 mainly and occassionally 4
4. Create a glide path to atleast a 20 with hand files prior to
using a rotary - I use Protapers and Profiles and supplement
with them patency files after every rotary use to maintain
patency- Lots of irrigation and at times Endoactivator to
5. In severe apical curves - prebending your files helps a lot,
in some cases I do use the reciprocating hand piece
- not this one!
The main TIP is TIME, INTENTION + PATIENCE - Rajiv Patel
Dear Dr. Patel: Thanks to you very much for your response.
Two more questions please:
1.- I would like to know if you use the rotatory Protapers or
Profiles only in a rotational way or sometimes
you use them with a reciprocating handpiece, like M4 or
2.- Safe prebending the files: Do you use prebend in this case:
Flexo-files, K-files, Niti-files and till what number of
files: 25, 30 ? Also Protapers or Profiles?
Hi Laura, I haven't tried using Protapers in a reciprocating
handpiece....may be I am missing out..(: I do use them sometimes
for hand instrumentation and prebend them if necessary.
And to your 2nd question - I do pre-bend K- files keeping in
mind the previous curvatures obtained from the "scouters" -
smaller files (6,8,10..) Again in tight curves - it will take
repeated pre-bending to maintain the curvatures. Sometimes in
these tight/acute curvatures - my experience is that there is a
compromise if your intention is to obtain large apical sizes -
you risk altering the anatomy. Hence it will be case to case
with respect to apical size - Rajiv Patel
Hey Kendo, Yes - 3.7/ # 18 has been treatment planned for
sunshine and cold steel due to a all the signs of
a crack .The patient and the referral are both aware of it,
the patient wanted to wait untill 4th of July
fireworks for the extraction.....);. - Rajiv
I love the cases and the TIP too, Rajiv - Nuria